西安地区早产儿视网膜病变筛查的初步结果

Preliminary results of screening of retinopathy of prematurity in Xi＇an

目的探讨适合西安地区早产儿视网膜病变（ROP）的筛查标准并分析与ROP相关的高危因素。方法回顾性系列病例研究。收集西安地区2008年6月至2009年6月134例（268只眼）早产儿和低体重儿ROP筛查资料进行回顾性分析。参照我国卫生部制定的ROP筛查标准，结合本地具体情况，适度扩大筛查范围，将出生体重≤2000g或矫正胎龄≤34周的早产儿和低体重儿确定为本地区ROP筛查标准，并比较分析两个筛查标准所获结果。检查同时对受检儿全身情况进行评估与记录，分析ROP发生的全身高危因素。ROP患儿组与眼底正常儿组的出生孕周和出生体重比较，采用组间比较t检验；两组受检儿中有持续吸氧史者所占比例的比较，采用四格表资料的X^2检验；ROP与全身相关因素的分析，采用Fisher精确检验。以P〈0．05作为差异有统计学意义。结果西安地区134例（268只眼）早产儿和低体重儿中，共筛查出18例（36只眼）患有不同程度的ROP，ROP检出率约为13．43％。其中男、女性各9例；出生孕周28—34周，平均（30．58±1．97）周；出生体重880～1950g，平均（1388．89±268．39）g。18例ROP患儿均为双眼患病，其中ROP1期4例（8只眼）；ROP2期5例（10只眼），其中1例病变侵及Ⅱ区且伴附加病变；ROP3期伴附加病变5例（10只眼）；ROP4A期1例（2只眼）；ROP5期1例（2只眼）；退行性病变2例（4只眼）。按照卫生部制定的ROP筛查标准，西安地区134例早产儿和低体重儿中，仅108例需要筛查，可以涵盖所有ROP患儿，ROP检出率约为16．67％（18／108）。在接受筛查的134例早产儿和低体重儿中，眼底正常儿组的平均出生孕周为（32．56±2．00）周，平均出生体重为（1773．91±349．73）g，均明显高于ROP患儿组，差异有统计学意义（孕周t=3．90，P〈0．01；体重t=4．45，P〈0．01）；眼底正常儿组与ROP患儿组有持续吸氧史者所占比例分别为59．48％和61．11％，差异无统计学意义（X^2=0．017，P〉0．05）；缺血和缺氧性脑病及胎盘早剥在眼底正常儿组与ROP患儿组的比例分别为12．07％与33．33％（P=0．030）和0．86％与11．11％（P=0．047），差异有统计学意义；结果表明早产、低出生体重、缺血和缺氧性脑病、胎盘早剥等影响胎儿发育的相对缺氧因素与ROP的发生密切相关。结论西安地区ROP检出率与国内其他地区报道的数据相近。我国卫生部制定的ROP筛查标准适合西安地区的ROP筛查工作。早产、低出生体重及相对缺氧因素是ROP发生的高危因素。

Objective To investigate the appropriate criteria for the screening of retinopathy of prematurity （ROP） in Xi＇an region and to determine the risk factors for ROP. Methods Screening criteria were established basing on the ROP screening guidelines, implemented by Ministry of Public Health with minor modification. It included newborn infants with birth weight of 2000 g or less, or gestational age of 34 w or less. The results obtained by the present screening criteria were compared with those obtained from the national screening criteria. Gestation age and birth weight between groups of ROP and normal fundus were compared by Student t - test, the ratios of persistent oxygen inhalation were examined by Chi-square test, and the risk factors for ROP were analyzed by Fisher exact test. A P 〈 0. 05 was considered significanL Results In all the infants examined, 18 cases （36 eyes, 13.43% ） developed ROP, including 4 cases （8 eyes） suffering from stage 1, 5 cases （10 eyes） from stage 2 （one was affected in zone Ⅱ with plus disease）, 5 cases （10 eyes） from stage 3 with plus disease, 1 case （2 eyes） from stage 4 A, 1 case （2 eyes） from stage 5, and 2 cases （4 eyes） from regressed stage. In ROP eases, gestation age ranged from 28 to 34 w, （30. 58 ± 1.97） w; birth weight ranged from 880 to 1950 g, （ 1388. 89 ±268.39） g. Statistical analysis showed that, the gestation age and birth weight in normal fundus group were （32. 56± 2.00）w and （ 1773. 91 ±349. 73 ） g respectively, which were higher than group of ROP （ gestation age t = 3.90, P 〈 0. 01 ; birth weight t = 4. 45, P 〈 0. 01 ）. The ratios of persistent oxygen inhalation in group of normal fundus and ROP were 59.48% and 61.11% （ X^2 = 0. 017, P 〉 0. 05 ）. It was also observed that the ratios of hypoxie- isehemie encephalopathy and placenta abruption in those two groups were 12.07%, 33.33% （P =0. 030） and 0. 86%, 11.11% （P =0. 047）. Clinical analysis indicated that prematurity, low birth weight, hypoxie-isehemie encephalopathy and placenta abruption were closely related to the occurrence of ROP. On the other hand, if using national screening criteria, only 108 infants in all 134 cases required screening, and all of the ROP cases could be detected with a detection rate at 16. 67%. Conclusions The detection rate of ROP is 13.43% （18/134） in the present study, which is consistent with the results obtained in previous studies in China. The national criteria are appropriate for the ROP screening in Xi＇an region. Prematurity, low birth weight and the relative hypoxia are high risk factors for the occurrence of ROP.